Current applications of augmented reality in urology: clinical practice, training, and future directions: an EAU endourology and YAU opinion

PURPOSE OF REVIEW: Augmented reality and related extended-reality technologies have been increasingly investigated in urology to support procedures characterized by complex three-dimensional anatomy and limited intraoperative visualization. This review synthesizes recent original evidence on augmented reality/extended-reality applications in urology across clinical practice and training, with a focus on procedural planning, intraoperative guidance, and educational outcomes. RECENT FINDINGS: A total 25 studies were identified. In Endourology, randomized studies in percutaneous nephrolithotomy (58-175 patients) showed improved anatomical understanding, shorter renal access times (50-60% reduction), changes in access strategy in 30% of cases, higher stone-free rates, and fewer intermediate-grade complications, with inconsistent effects on operative duration and fluoroscopy exposure using augmented reality/extended-reality applications.In robotic urology, most evidence concerns oncological surgery. Feasibility and comparative studies in robot-assisted partial nephrectomy (20-105 patients) confirmed rapid augmented reality co-registration and acceptable perioperative safety. In radical prostatectomy, comparative and randomized data (92-133 patients) suggested lower positive surgical margin rates at preserved neurovascular bundles and improved early continence recovery, without consistent differences in short-term oncological outcomes. Applications to pelvic lymph node dissection and highly complex renal surgery remain exploratory.Educational and training applications represent the most mature domain, with randomized and validation studies (12-43 trainees) consistently demonstrating improved technical performance, procedural efficiency, and reduced cognitive workload using immersive or mixed-reality platforms, including remote training solutions. SUMMARY: Current augmented reality/extended-reality applications in urology show reproducible benefits in anatomical understanding, procedural planning, and selected technical steps, particularly in endourology and surgical training. Clinical outcome evidence remains heterogeneous and largely limited to short-term or surrogate endpoints, while broader adoption is constrained by technical robustness, workflow integration, and scalability. Ongoing randomized studies and advances in automation and artificial intelligence-driven registration are expected to better define the role of augmented reality/extended-reality in routine urological practice.